Medicinal Drugs

– in the House of Commons at 9:47 pm on 11th December 1996.

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Motion made, and Question proposed, That this House do now adjourn.—[Mr. McLoughlin.]

10 pm

Photo of Paul Flynn Paul Flynn , Newport West

Medicinal drugs are one of the great triumphs of science. They relieve the pain of millions of people and provide longer, healthier lives. Britain has better safeguards and less drug use—[Interruption.]

Photo of Mr Geoffrey Lofthouse Mr Geoffrey Lofthouse , Pontefract and Castleford

Order. Hon. Members leaving the Chamber should please do so quietly.

Photo of Paul Flynn Paul Flynn , Newport West

Medicinal drugs are one of the great triumphs of science. They relieve the pain of millions of people and provide healthier, longer lives. In many cases, Britain has higher standards and a lower rate of drug use than many other European countries. Drugs are wonderful servants but fearful masters—if misused, they can be the cause of death or disease on a prodigious scale.

In this short debate, it is possible to give only a few snapshots of the many current concerns, which include the 2,000-plus deaths from prescription and over-the-counter drugs, the over-medication of the elderly in residential homes, the hazards of road users whose senses are dulled by psycho-active drugs, the growing availability of potentially lethal doses of drugs, and, perhaps most important, the worldwide growth of antibiotic-resistant bacteria, which is leading to untreatable forms of ancient diseases. There is also concern about the use of antibiotics on animals and the possibility of their transmission to human beings through the food chain.

I had a message from the Alzheimer's Disease Society tonight. It wants to emphasise the fact that the sad cases illustrated in the recent "World in Action" programme, which showed the misuse of anti-psychotic drugs in residential homes, were not uncommon but are a feature of falling standards in residential and nursing homes. The society asked me to express its support for my call for a full inquiry into drug use.

In March 1996, the British Medical Journal gave a very disturbing account of an investigation carried out by researchers in Glasgow into anti-psychotic drugs called neuroleptics. They visited 28 nursing homes and examined the prescribing of what has been called a "chemical cosh" to 217 of the residents. Narcoleptics were considered to be appropriate for only 12 per cent. of them; 190 others had been prescribed them for wholly incorrect reasons—reasons which meant that the homes were probably easier to run but which left the elderly in greater confusion than ever.

The authors concluded that the results were a cause for grave concern, as the drugs have side effects that produce symptoms similar to those of Parkinson's disease. However, the most devastating conclusion of all from the Glasgow researchers was that American studies had proved that, when the use of these powerful drugs was reduced or stopped altogether, even in appropriate cases there was little, if any, deterioration in the patient's behaviour.

The great worldwide threat was illustrated in September in the journal Nature, which used language that is rare for a sober scientific journal: The increased incidence of penicillin resistant bacteria is putting the treatment of serious childhood diseases in jeopardy — multi-resistant TB is becoming the norm". It reported on the intense frustration of international scientists at a conference in London in the summer at the failure to mount a sustained campaign against what they described as the spread of resistance, which is an ecological disaster". They recommended that we should use antibiotics more sparingly and prudently. The magic bullet that did so much good is losing its potency. A week ago, it was discovered that a disease was being fed and was growing stronger and more virulent on an antibiotic, which is an extraordinary turnabout.

Epidemics are now sweeping the planet. They are far worse in remote lands in Africa and South America. Although they have touched the United States of America, none has affected us to any great extent, with the exception of methicillin-resistant staphylococcus aureus. One bacterium, which is resistant to all known antibiotics, is the principal cause of all childhood deaths in Africa. That is an extremely serious problem. It could appropriately be described as a disaster.

In this city and in this Parliament, our lives were touched by the moving words of Lord Fitt about the death of his wife. He explained that she was suffering from asthma and was taking cortisone, which is a steroid drug. They were worried that she was taking too much of the drug, so she was admitted to hospital to try to get her on to less damaging drugs. Sadly, she shared a ward with someone with MRSA—the lethal hospital bug created by drug over-use. Tragically, Lady Fitt died a few weeks later.

On 16 April this year, the Minister for Health gave me figures on deaths caused by paracetamol. I thank him for that. We have had a long and often heated and angry correspondence, but I think that we now agree about the number of deaths caused by paracetamol. The minimum figure is about 200 a year.

In a recent reply, the Minister gave me the gross figures, which were 452 in 1993, 453 in 1994 and 568 in 1995. That is a huge number of deaths, given that Ecstasy, which everyone is worried about, accounts for 10 deaths a year. Co proximal accounts for 250 deaths a year, dothiepin for 150 deaths, and in America 7,000 deaths a year are caused by aspirin. Those are not drugs to cure life-threatening illnesses: they cure fairly minor illnesses. Drugs that kill people are the familiar, over-the-counter drugs. They are like loaded guns in the medicine chests of almost every home in the land.

Two years ago, a 12-year-old girl in Pontefract was sent out on a trial to buy 50 paracetamol tablets, which was enough to kill her three or four times over. She had no difficulty buying 50, but many people tried to sell her 100. It was not the pharmacists who pushed the drugs the most, but the supermarkets and the garages.

Cheaper, more accessible drugs may be on the way. The Office of Fair Trading is considering the alleged restrictive practice in a first step to abolishing controls on cheaper medicines. A 12-year-old girl may go into Asda and for 25p be able to buy enough paracetamol to kill her twice over.

The Government must take responsibility, because they reversed the 1978 reforms which restricted the sales of some over-the-counter medicines as people were becoming addicted to them. Some of those drugs are back on the market, including Paramol 118, which contains morphine and paracetamol. It is fast becoming a major street drug, which is open to abuse as it is an alternative for heroin users. There is even a new help organisation with 2,000 members for what the organiser calls a hidden army of high street junkies, many of whom are hooked on drugs which, until recently, had been available only on prescription.

Drugs also play a part in road accidents. There are 100 million annual prescriptions—a vast figure—for drugs such as tranquillisers, anti-depressants and sleeping pills, which make the user more intoxicated, less able to drive a car and slower in reacting than if that person was above the alcohol limit. The European Road Safety Federation estimates that 10 per cent. of road deaths are caused by drivers affected by medicinal drugs—350 deaths a year in Britain.

Another legitimate cause for concern is the use of antibiotics on animals. Strict limits are laid down so that the antibiotics used for animals are different from those used for human beings. But there is one major problem involving one antibiotic. The danger is that it will get into the food chain and we will become resistant to it. That drug has been banned in Germany and Denmark, but not here. A powerful lobbying organisation in Europe is trying to prevent such a ban, despite the fact that it would be sensible.

Objective science is saying, with one loud, unanimous voice, that there is vast over-use of medicinal drugs. It pleads with the Government to take action, because the bacteria are winning. Patients' organisations and consumer associations all say that we are an over-medicated nation. Health physician Martin Fischer, from Charing Cross hospital, said that half the modern drugs could well be thrown out of the window were it not for the fact that the birds might eat them.

We are less compassionate to ourselves and our children than we are to the birds. Society has been conditioned to believe that every pain, discomfort, grief and moment of boredom suffered must have a remedy in a drug. That myth is the creation not of doctors but of those who are selling the drugs and making large profits from them.

Which? published a devastating report on people's widespread ignorance of the drugs they take. A survey of asthma sufferers showed that 61 per cent. were taking drugs—aspirin and ibuprofen—that can trigger symptoms of asthma. Half those surveyed suffering from high blood pressure were taking remedies that would increase their risk of heart problems. There is widespread ignorance among patients of the drugs that are prescribed.

Many actions can be taken. We need a major inquiry into the use of all drugs. We want restraint in prescribing and no attempt to liberalise the present system or to make drugs cheaper, as supermarkets such as Asda want. The sale of lethal addictive drugs should be confined to pharmacists, with limits on their sales. We should publicise the great dangers to road users who are intoxicated by drugs. We should improve hospital isolation facilities and hygiene standards, preferably with nurse-led wards, as suggested by the King's Fund.

There should be more of the so-called brown bag trials, where the elderly, who are the worst over-medicated group in society, are called in to explain to doctors what they are taking. Up to 15 per cent. of all elderly people are taking up to six different drugs each, the cocktail effect of which is the cause of many problems. Many trials are being carried out to re-examine such use and to give advice. We need an urgent inquiry into the medication of elderly people in residential homes, and we need a campaign of public education to persuade regular routine users of familiar medicines of the problems they cause.

The European body of specialists in research into headaches said that the main cause of headaches was paracetamol and aspirin. Timothy Steiner of Charing Cross hospital said: There are a lot of people who have daily headaches who take daily analgesics. If they stop the analgesics the headaches go away.

For many people, medicinal drugs are often essential life savers, but the greatest scientific wonder that any of us have ever encountered is the human body. It has miraculous restorative powers that are natural, and safer than many failing and dangerous chemical medicines, in which we have unwisely placed our trust.

Photo of Dr Alan Williams Dr Alan Williams , Carmarthen 10:14 pm, 11th December 1996

I am grateful for the opportunity to make a few remarks in this debate. I congratulate my hon. Friend the Member for Newport, West (Mr. Flynn) on securing the parliamentary time. I should like to confine my remarks to MRSA—methicillin-resistant staphylococcus aureus—and underline the serious threat that that poses to anyone who goes to hospital for treatment.

I first heard of MRSA in 1993, when a friend telephoned me to say that there were a few cases of the antibiotic-resistant strain in my local Carmarthen hospital. I wrote to the hospital and met the chief executive and the public health laboratory consultant there. I was reassured that the number of cases was quite small.

At the hospital, in 1989, there were two MRSA cases; in 1990 there were two; in 1991 there were five; in 1992 there were 10; and in 1993, the year when I first heard of MRSA, there were 13. I spoke at the time to my brother who was a consultant in a London hospital. He said that MRSA was common in London hospitals, but that in Wales we did not have a particular problem.

I tabled some parliamentary questions at that time, and wrote to the Welsh Office. Generally. I received non-answers. The Welsh Office said that the information was not available, and not collated centrally. The reply that I received from the Under-Secretary of State for Wales was: The information … is not routinely collected"— MRSA, in a sense, was too unimportant in 1993 for the figures to be collated centrally. I kept reading about MRSA incidents, however, in local and national newspapers. In July, I again tabled questions to the Welsh Office, and I was pleased that the information was now being made available and collated.

In my hospital, in 1994, there were 18 declared MRSA cases, in 1995, there were 36, and to July 1996, there have been 49 cases. That was a tenfold increase during that five-year period. Figures in parliamentary replies to my hon. Friend the Member for Newport, West show that, for Wales, in 1995 the total was 442, and that this year to date it is 2,100. That is a fivefold growth in the past year.

I am glad that the information is now being collated centrally and made available. A parliamentary reply from the Department of Health to a further question on 3 December showed that, in England and Wales, there were 2,286 MRSA cases in 1992 and 17,063 in 1995. During those three years, there had been a sevenfold growth in the incidence of MRSA in hospitals in England and Wales. That is disturbing. What was a small problem in the late 1980s and early 1990s has become a major problem. I know two people—members of the Labour party, as it happens—in my constituency who last year contracted MRSA while in hospital.

My hon. Friend the Member for Newport, West quoted the speech on 4 November by Lord Fitt, whose personal tragedy highlighted the problems that the bug is causing in hospitals.

The problem of antibiotic-resistant bugs is international and widespread. I only wish that the Government would take it more seriously. First, the Department of Health needs to liaise with the British Medical Association and the Medical Research Council to persuade general practitioners to prescribe antibiotics only when they are necessary.

Secondly, it is absurd for animal feeds to routinely contain antibiotics so that animals gain weight faster. It is done for economic, not health, reasons. Thirdly, there needs to be research into new antibiotics. We are in a race against new super-bugs that are adapting and modifying to become resistant to antibiotics. The Department of Health and the pharmaceutical companies must redouble their efforts to develop new antibiotics to address that increasing problem.

Photo of Mr Gerald Malone Mr Gerald Malone , Winchester 10:20 pm, 11th December 1996

I am pleased to have the opportunity to respond to the important debate initiated by the hon. Member for Newport, West (Mr. Flynn) and the points raised by the hon. Member for Carmarthen (Mr. Williams). They have raised a wide range of issues, and I am sure that they will understand that I cannot cover them all in great detail in the 10 minutes available to me.

First, I should like to reassure the hon. Gentlemen that Britain has one of the most effective control and licensing systems for drugs in any developed country, through the combination of the Medicines Control Agency and the Committee on Safety of Medicines. As the hon. Member for Newport West said, it is important that we do not have a closed mind on developments. The system for investigating the efficacy of drugs and the problems they may cause is a constant process of re-evaluation. Those who are charged by Government with the responsibility constantly to examine such matters on behalf of the public need to review their decisions in the light of any new evidence that emerges.

The hon. Member for Newport, West was quite right to point to the enormous benefits of modern medicine. The proper use of medicines relieves human suffering and cures or alters the course of many life-threatening diseases. However, modern medicine also involves a number of risks, and some concerns have been expressed about antibiotic-resistant organisms.

It is not a new phenomenon. One might think from the lurid headlines on the issue that we are hurtling towards a post-antibiotic era, and that the problem has only just been spotted. That is not the case. It was identified at an early stage in the use of antibiotics, and was countered by conventional infection control techniques and other intervention strategies, such as limiting or rotating their use. Those methods were successful, but they were also overshadowed by what at the time seemed to be a plentiful supply of new antibiotics. Between 1939 and 1972, for example, more than 30 new antibiotics were discovered. In more recent years, however, the number has fallen.

Microbial antibiotic resistance has always been an issue, but the need to address it has now become more focused. It has to be managed better. In considering new strategies and policies to combat its spread, we need to ensure that we make the best use of those antibiotics currently available, and perhaps be prepared to re-learn a number of lessons from the past.

The hon. Member for Newport, West referred to the particular problems that are found in other countries. It might be useful for the purpose of this Adjournment debate to look at the difference between this and those other countries.

Photo of Mr Gerald Malone Mr Gerald Malone , Winchester

I do not intend to give way. I have a limited period in which to answer a very complex debate.

In many countries, the spread of such types of micro-organisms has now been accepted as more or less inevitable. That is not so in the United Kingdom. One of our most effective weapons is the high quality of the infection control systems in our health service and hospitals. We also maintain—the hon. Member for Newport, West asked for reassurance on them—very strict controls over accessibility to antibiotics by ensuring that they are available only on prescription. That is very different from what happens in other countries—even other countries in Europe—where antibiotics are available over the counter, and very readily too. We are concerned about the matter.

MRSA was especially mentioned. It has attracted many headlines recently, and it is not helpful when phrases such as "killer bug" and "super-bug" are used. They have invoked anxiety among many patients and their families and friends, and conjured up images of a modern-day health care system that cannot cope with such problems.

It might be important to put on the record the fact that MRSA is an antibiotic-resistant form of a fairly common bacterium, staphylococcus aureus. It is one of the most common of all bacteria—it is present in about one third of the population—but a problem occurs when it gets out of control, which may have alarming effects. How do we deal with it in the NHS?

Specifically to tackle the problem, clinical guidelines on MRSA have been developed over recent years. Such guidance includes that jointly published, for example, in 1986 by the Hospital Infection Society and the British Society for Antimicrobial Chemotherapy. The guidance was updated, republished in 1990 and formally commended by the Department of Health to the NHS in 1994. We are working with professional groups on how to take that further forward. We are of course concerned about such issues and alert to them, and will continue to update guidance as necessary.

The hon. Member for Newport, West raised an important point about treatment of elderly people, which I take extremely seriously. We issue advice on prescribing issues that include prescribing particularly for elderly patients, which is available to GPs from a range of sources. GPs are, of course, ultimately responsible for the prescriptions they write for their patients.

The Department publishes publications such as the British National Formulary, which is regularly updated and provides advice for all doctors. A number of bulletins also provide prescribing advice for all GPs. Copies of the British National Formulary are available in the Library if the hon. Member for Newport, West wants to have a look at it.

Concerns were expressed about the availability of medicines for children. Under guidelines issued by the Royal Pharmaceutical Society in relation to its code of ethics, a pharmacist should not supply medicine to children, regardless of whether they are receiving medicine for their own use or, as quite often happens, as a messenger for others, unless the pharmacist is satisfied that the product will be used correctly and delivered safely to an adult.

I listened carefully to what the hon. Members for Newport, West and for Carmarthen said about the issue, and I am pleased to be able to reassure them that we are actively considering the need for further restrictions on the sale of medicines to children. If there is evidence of a problem, we shall certainly react to it.

The hon. Member for Newport, West mentioned the problem of paracetamol as he sees it. He is a doughty campaigner on the issue. Paracetamol is a safe medication for the relief of pain, but it is recognised that, if it is abused contrary to the instructions for use, problems result from an unexpected reaction to the drug, causing liver failure, which is not immediately apparent after the drug is taken. That is why consultation is occurring on what should happen about pack sizes.

We take very seriously indeed the points that have been raised by the hon. Members for Newport, West and for Carmarthen. The hon. Member for Newport, West is quite right to say that the matters are on-going and will always require the Government's interest. I give him the reassurance that we shall continue to look at them. A number of other points were raised with which, in the short time left to me, I have not been able to deal, but I shall write to the hon. Gentleman about them. As always, he made a constructive contribution to an extremely important matter.

Question put and agreed to.

Adjourned accordingly at twenty-nine minutes past Ten o'clock.